Individual provider Active NPI

Meron Wilson, PA

  • Physician Assistant
  • Fayetteville, NC
National Provider Identifier
1467085746
Registry record updated Sep 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-09503 Issued in NC
Practice address
806 Hay St
Fayetteville, NC 28305-5312
Phone
(910) 860-7008
Fax
(910) 824-7593
NPI assigned
Feb 15, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X 0010-09503 NC Primary

Addresses

Primary practice location

806 Hay St
Fayetteville, NC 28305-5312

Mailing address

806 Hay St
Fayetteville, NC 28305-5312
Phone (910) 860-7008

Other names 1

  • Meron Gizaw Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210217000703 NC Practitioner - Physician Assistant 3678988052 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Haymount Institute for Psychological Services PLLCGroup PAC ID 1153498415, 29 clinicians

Practice addresses (Care Compare)

131 W Edinborough Ave
Raeford, NC 28376-2861
Phone (910) 860-7008

806 Hay St
Fayetteville, NC 28305-5312
Phone (910) 860-7008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-09503NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Haymount Institute for Psychological Services, PLLC Physician Assistant CurrentSince Feb 8, 2021 Accepting new patients

Locations

806 Hay St
Fayetteville, NC 28305
Phone 9108607008117

996 Helen St
Fayetteville, NC 28303
Phone (910) 635-0115

3507 Hill St
Hope Mills, NC 28348
Phone (910) 339-0901

131 W Edinborough Ave
Raeford, NC 28376
Phone (910) 848-1222

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1467085746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 HAY ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055312",
            "telephone_number": "910-860-7008",
            "fax_number": "910-824-7593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 HAY ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055312",
            "telephone_number": "910-860-7008",
            "fax_number": "910-824-7593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MERON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-15",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-09503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MERON",
            "last_name": "GIZAW",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.